Predictors of Nonroutine Discharge After Surgical Treatment of Ruptured Intracranial Aneurysms: An American College...

Nonroutine discharge (NRD) from the hospital carries considerable cost. We identified predictors of NRD after surgical treatment of ruptured intracranial aneurysms (IAs).

The American College of Surgeons National Surgical Quality Improvement Program database was searched for patients with surgically treated ruptured IAs from 2016 through 2020. Demographics, clinical characteristics, preoperative comorbidities, procedural details, and 30-day morbidity and mortality were extracted. NRD risk factors were determined by multivariate logistic regression. Surgical outcomes and postoperative complications were compared by aneurysm complexity and location after propensity score matching.

Among 671 patients, 277 (41%) had NRD, 591 (88%) underwent emergent surgery, and 466 (69%) had complex aneurysms. After matching, complex aneurysms were associated with higher frequencies of postoperative pneumonia (16% vs. 10%, P = 0.04), NRD (45% vs. 32%, P = 0.01), and 30-day reoperation (21% vs. 13%, P = 0.03). Aneurysms in the vertebrobasilar circulation were associated with a higher frequency of postoperative urinary tract infection (13% vs. 5%, P = 0.01) and organ/space surgical site infection (4% vs. 0.7%, P = 0.02). On multivariable analysis, NRD was associated with age ≥65 years (odds ratio [OR] 2.76), Black/African American (OR 1.86) or White (OR 2.16) race, preoperative immunosuppressive or steroid therapy (OR 4.46), complex aneurysms (OR 1.75), emergent surgery (OR 2.37), length of stay ≥21 days (OR 2.94), and postoperative pneumonia (OR 3.64) or sepsis (OR 5.64).

Predictors of NRD after ruptured IA surgery included patient demographics, aneurysm characteristics, and postoperative complications. Early identification of high-risk patients and targeted discharge planning could reduce NRD rates.